Int J Antimicrob Agents. 2023 Jun 18:106895. doi: 10.1016/j.ijantimicag.2023.106895. Online ahead of print.
ABSTRACT
INTRODUCTION: Although approximately 40 years have passed since Japanese spotted fever (JSF) was first reported in Japan, its treatment has not been standardized yet. As in other rickettsial infections, tetracycline (TC) is the first-line treatment, but successful cases of fluoroquinolone (FQ) combination therapy in severe cases have been reported. However, the effectiveness of TC plus FQ combined treatment (TC+FQ) remains controversial. Therefore, we evaluated the antipyretic effect of TC+FQ.
METHODS: A comprehensive search of published JSF case reports was conducted to extract individual patient data. In the cases where we were able to extract temperature data, after homogenizing patient characteristics, we evaluated the time-dependent changes in the fever type from the date of the first visit for the TC and TC+FQ groups.
RESULTS: The primary search yielded 182 cases, with the individual data evaluations resulting in a final analysis of 102 cases (84 in the TC group and 18 in the TC+FQ group), which included the temperature data. The TC+FQ group had significantly lower body temperatures as compared to the TC group from day 3 to day 4.
CONCLUSIONS: Although TC monotherapy for JSF can produce defervescence after a while, the fever duration is longer as compared to other rickettsial infections, such as scrub typhus. Results suggest that TC+FQ was more effective for the antipyretic effect, with a potential shortening of the duration that patients suffer from the febrile symptoms.
PMID:37339710 | DOI:10.1016/j.ijantimicag.2023.106895
